Healthcare Provider Details

I. General information

NPI: 1992925705
Provider Name (Legal Business Name): VASANTI DEUSKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N. HWY 89
PRESCOTT AZ
86313
US

IV. Provider business mailing address

16255 N. INDIAN RUINS ROAD
PRESCOTT AZ
86305
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4860
  • Fax:
Mailing address:
  • Phone: 928-899-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number16619
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: